SPARK Referral Form
SPARK is a free, home-based, kindergarten readiness program for families who reside in Franklin County.  A Parent Partner will meet with you one to two times a month and will work with you to help your child build the skills necessary for success in school.  You may submit a referral anytime, however, enrollment will depend on  the child's age, time of year, etc.  Families can join the program one to two years before the child enters kindergarten.  Children who participate in SPARK outperform their peers at least through the fifth grade.

Note:  You may submit a referral for children who are younger than 3.
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Date of Referral *
MM
/
DD
/
YYYY
What is the primary language spoken in the home? *
Would you like us to contact you with an interpreter? *
Child's Name *
First & Last
Child's Birthdate *
MM
/
DD
/
YYYY
Street Address *
City *
Zip Code *
Parent/Guardian Name *
First & Last
Parent/Guardian Preferred Pronouns *
Relationship to Child *
Parent/Guardian Phone Number *
(xxx) xxx-xxxx
Parent/Guardian Email Address *
Preferred Method of Contact *
Required
Is child in preschool/childcare? *
If yes, where is the child enrolled?
What school district do you live in? *
Do you receive TANF benefits (SNAP, food stamps, Medicaid, etc)? *
Preferred day for visits? *
Required
Preferred time of day for visits? *
Required
How did you hear about the program? *
Please include name, email, and phone number if applicable.
Notes:
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